Healthcare Provider Details

I. General information

NPI: 1871712117
Provider Name (Legal Business Name): MAURY MALYN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W LANCASTER AVE SUITE 230
DEVON PA
19333-1592
US

IV. Provider business mailing address

775 WEADLEY RD
RADNOR PA
19087-2852
US

V. Phone/Fax

Practice location:
  • Phone: 610-687-8088
  • Fax:
Mailing address:
  • Phone: 610-687-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008284L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: